Supplementary motor area connectivity and dual-task walking variability in multiple sclerosis

Fritz, Nora; Kloos, Anne; Kegelmeyer, Deborah; Kaur, Parminder; Nichols-Larsen, Deborah S.

doi:10.1016/j.jns.2018.11.015

Cited by 17 publications

(10 citation statements)

References 61 publications

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“…Additionally, dual-task walking requires increased cognitive and motor demands [ 9 ]. Due to the high prevalence of cognitive (65%) and motor deficits (85%) in MS [ 10 ], it is not surprising that impairments in dual-task walking are seen in individuals with MS [ 11 – 14 ] and have been related to cognition, fall risk [ 15 ], dynamic balance control [ 7 ], and connectivity in the supplemental motor area [ 16 ]. Moreover, dual-task performance is modulated by neurobiological systems [ 17 , 18 ] affected in MS, like the dopaminergic system [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Backward Walking and Dual-Task Assessment Improve Identification of Gait Impairments and Fall Risk in Individuals with MS

Edwards

Kegelmeyer

Kloos

et al. 2020

Multiple Sclerosis International

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Background. Individuals with multiple sclerosis (MS) experience deficits in motor and cognitive domains, resulting in impairment in dual-task walking ability. The goal of this study was to compare performance of forward walking and backward walking in single- and dual-task conditions in persons with MS to age- and sex-matched healthy controls. We also examined relationships between forward and backward walking to cognitive function, balance, and retrospective fall reports. Methods. All measures were collected in a single session. A 2×2×2 mixed model ANOVA was used to compare differences in forward and backward walking in single- and dual-task conditions between MS and healthy controls. Spearman correlations were used to examine relationships between gait and cognitive function, falls, and balance. Results. Eighteen individuals with relapsing-remitting MS and 14 age- and sex-matched healthy controls participated. Backward walking velocity revealed significant differences between groups for both single-task (p=0.015) and dual-task (p=0.014) conditions. Persons with MS demonstrated significant differences between single- and dual-task forward and backward walking velocities (p=0.023; p=0.004), whereas this difference was only apparent in the backward walking condition for healthy controls (p=0.004). In persons with MS, there were significant differences in double support time between single- and dual-task conditions in both backward (p<0.001) and forward (p=0.001) directions. More falls at six months were significantly associated with shorter backward dual-task stride length (r=−0.490; p=0.046) and slower velocity (r=−0.483; p=0.050). Conclusion. Differences in MS and age- and sex-matched healthy controls are more pronounced during backward compared to forward walking under single- and dual-task conditions. Future work with a larger sample size is needed to validate the clinical utility of backward walking and dual-task assessments and mitigate the limited sensitivity of the current dual-task assessments that primarily rely upon forward walking.

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Section: Introductionmentioning

confidence: 99%

Backward Walking and Dual-Task Assessment Improve Identification of Gait Impairments and Fall Risk in Individuals with MS

Edwards

Kegelmeyer

Kloos

et al. 2020

Multiple Sclerosis International

Self Cite

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“…As interactions between motor and cognitive functions are known in MS, linking them together (termed dual-tasking) can be used to evaluate the interference of performing a cognitive task during gait assessment [73,74,[132][133][134].…”

Section: Cognitionmentioning

confidence: 99%

Digital Biomarkers in Multiple Sclerosis

et al. 2021

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For incurable diseases, such as multiple sclerosis (MS), the prevention of progression and the preservation of quality of life play a crucial role over the entire therapy period. In MS, patients tend to become ill at a younger age and are so variable in terms of their disease course that there is no standard therapy. Therefore, it is necessary to enable a therapy that is as personalized as possible and to respond promptly to any changes, whether with noticeable symptoms or symptomless. Here, measurable parameters of biological processes can be used, which provide good information with regard to prognostic and diagnostic aspects, disease activity and response to therapy, so-called biomarkers Increasing digitalization and the availability of easy-to-use devices and technology also enable healthcare professionals to use a new class of digital biomarkers—digital health technologies—to explain, influence and/or predict health-related outcomes. The technology and devices from which these digital biomarkers stem are quite broad, and range from wearables that collect patients’ activity during digitalized functional tests (e.g., the Multiple Sclerosis Performance Test, dual-tasking performance and speech) to digitalized diagnostic procedures (e.g., optical coherence tomography) and software-supported magnetic resonance imaging evaluation. These technologies offer a timesaving way to collect valuable data on a regular basis over a long period of time, not only once or twice a year during patients’ routine visit at the clinic. Therefore, they lead to real-life data acquisition, closer patient monitoring and thus a patient dataset useful for precision medicine. Despite the great benefit of such increasing digitalization, for now, the path to implementing digital biomarkers is widely unknown or inconsistent. Challenges around validation, infrastructure, evidence generation, consistent data collection and analysis still persist. In this narrative review, we explore existing and future opportunities to capture clinical digital biomarkers in the care of people with MS, which may lead to a digital twin of the patient. To do this, we searched published papers for existing opportunities to capture clinical digital biomarkers for different functional systems in the context of MS, and also gathered perspectives on digital biomarkers under development or already existing as a research approach.

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“…The first two walks are performed at a self-selected comfortable walking speed; the following two walks are performed under a dual task challenge, which usually involves two tasks (a word fluency and a calculation task). This method increases sensitivity to show gait abnormalities which cannot be detected during normal walking (Fritz et al, 2019). Since cognitive deficits, for example concentration problems, are a frequent symptom in pwMS, patients with increased cognitive impairment need more attention while walking in order to compensate further disorders (reduced muscle capacity, balance or vision problems).…”

Section: Assessment Of Walking Quality With and Without Cognitive-motmentioning

confidence: 99%

The Dresden Protocol for Multidimensional Walking Assessment (DMWA) in Clinical Practice

et al. 2020

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Walking impairments represent one of the most debilitating symptom areas for people with multiple sclerosis (MS). It is important to detect even slightest walking impairments in order to start and optimize necessary interventions in time to counteract further progression of the disability. For this reason, a regular monitoring through gait analysis is highly necessary. At advanced stages of MS with significant walking impairment, this assessment is also necessary to optimize symptomatic treatment, choose the most suitable walking aid and plan individualized rehabilitation. In clinical practice, walking impairment is only assessed at higher levels of the disease using e.g., the Expanded Disability Status Scale (EDSS). In contrast to the EDSS, standardized functional tests such as walking speed, walking endurance and balance as well as walking quality and gait-related patient-reported outcomes allow a more holistic and sensitive assessment of walking impairment. In recent years, the MS Center Dresden has established a standardized monitoring procedure for the routine multidimensional assessment of gait and balance disorders. In the following protocol, we present the techniques and procedures for the analysis of gait and balance of people with MS at the MS Center Dresden. Patients are assessed with a multidimensional gait analysis at least once a year. This enables long-term monitoring of walking impairment, which allows early active intervention regarding further progression of disease and improves the current standard clinical practice.

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Supplementary motor area connectivity and dual-task walking variability in multiple sclerosis

Cited by 17 publications

References 61 publications

Backward Walking and Dual-Task Assessment Improve Identification of Gait Impairments and Fall Risk in Individuals with MS

Backward Walking and Dual-Task Assessment Improve Identification of Gait Impairments and Fall Risk in Individuals with MS

Digital Biomarkers in Multiple Sclerosis

The Dresden Protocol for Multidimensional Walking Assessment (DMWA) in Clinical Practice

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